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HealthPayerIntelligence News

Congress Opens Probe into Short-Term Limited Duration Insurance

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The House Energy & Commerce Committee (E&C) has opened an inquiry into short-term limited duration insurance (STLDI) plans and companies that may be acting against consumer interests by selling these health coverage options. The...

Prescription Drug Spending Increased Nearly $100B from 2012 to 2016

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Net prescription drug spending increased from $250.7 billion in 2012 to $341 billion in 2016, according to a new report from the Pew Charitable Trusts. The report also found that over the same period, the share of commercial insurance...

Humana Expands Value-Based Care Options for Medicare Advantage

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Humana has announced a series of initiatives to increase value-based care for orthopedic services among its Medicare Advantage members. The organization will partner with orthopedic and neurosurgery practices to launch a new value-based...

AMA: Payers Moving Too Slowly on Prior Authorization Fixes

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Physicians are still frustrated by problematic prior authorization (PA) procedures and believe that health payers are moving too slowly on necessary solutions, finds a new survey by the American Medical Association (AMA). Building on data...

Cambia Health Solutions, Blue Cross NC Enter Strategic Affiliation

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Cambia Health Solutions and Blue Cross of North Carolina have announced a new strategic affiliation that will combine management operations into a single entity retaining the Cambia name. The two not-for-profit companies hope that the...

Trump Budget Proposes Medicaid Block Grants, Big Medicare Cuts

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In its 2020 fiscal year federal budget, The Trump Administration is proposing a significant reconfiguration of the nation’s healthcare landscape by rolling back Medicaid expansion, creating state Medicaid block grants, and...

Payers, Providers, Lawmakers Debate Surprise Billing Guidelines

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State and federal policymakers are still considering various approaches to solve surprise billing issues and compensate out-of-network providers, including mandated values for reimbursement and independent dispute resolution, according to...

Revised Tax Policies Needed to Reduce Individual Market Premiums

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Policymakers should revise current tax policies and work to eliminate financial barriers to health insurance in order to reduce individual market premiums, says a new brief from the Blue Cross Blue Shield Association (BCBSA). Over 14...

UnitedHealth Behavioral Health Unit Used Flawed Denials Guidelines

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A federal court has found that United Behavioral Health (UBH), a unit owned by UnitedHealth Group, used a flawed methodology to deny mental health and substance abuse treatment services to beneficiaries. UBH, which also operates as...

CMS Seeks Comment on Purchasing Health Insurance Across State Lines

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CMS is soliciting public comments on strategies that would allow enrollees to purchase health insurance across state lines in an effort to increase competition and improve affordability for consumers. The request for information (RFI)...

Amazon-Backed Health Venture Reveals Name: Haven Healthcare

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The partnership between Amazon, Berkshire Hathaway, and JPMorgan Chase now has a name in addition to a high-profile executive team.  The venture, which aims to reduce costs and develop innovative approaches to care will be known as...

Affordability Concerns Lead Consumers to Short-Term Health Plans

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Consumers are turning to short-term health plans primarily because they cannot afford other options, according to a new survey from insurance portal eHealth.com. Instead of using short-term plans to bridge gaps in more comprehensive...

CMS eMedicare Initiative Aims to Modernize Care for Beneficiaries

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CMS is seeking to modernize the way Medicare beneficiaries access information about their care and coverage with eMedicare, an initiative that uses online tools and mobile applications to improve beneficiary decision-making....

House Joins Senate in Urging Delay of Health Insurance Tax

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Democrats and Republicans from the House of Representatives have joined their Senate colleagues in introducing legislation to delay the ACA Health Insurance Tax for several years. Representatives Ami Bera (D-CA), Josh Gottheimer...

CMS: Healthcare Spending to Rise by 5.5% Annually to $6T in 2027

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National healthcare expenditures are expected to grow at an average of 5.5 percent annually from 2018 to 2027, reaching $6.0 trillion by 2027, according to a report from the Office of the Actuary at CMS. The report also projects that...

Noncitizens, Lawful Immigrants Much More Likely to Be Uninsured

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Non-US citizens, including immigrants lawfully present in the country, are significantly more likely than citizens to be uninsured, according to new data from the Kaiser Family Foundation (KFF). The uninsured rate for adult undocumented...

State Legislatures Debate Value of Association Health Plans

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State legislators in Vermont and North Carolina are considering legislation that would impact the viability of association health plans (AHPs) in their states. State bills in Vermont and North Carolina would alter the health insurance...

Prescription Drug Prices Set for 3.8% Increase in 2020

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Premier Inc. is projecting a 3.8 percent rate of inflation for prescription drug prices in plan year 2020, with non-acute care items comprising the majority of price increases. While price increases are never welcome, Premier notes that...

Payers, Trade Groups Defend Silver-Loading in Comments to CMS

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Major health payers and representative trade groups are urging CMS not to eliminate the practice of silver-loading, which has been used to stabilize premiums in a volatile and unpredictable market. In response to a request for comments...

70% of Employers Offer Packaged Health, Dental, Pharmacy Benefits

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Seventy-one percent of employers with 100 or more employees are either actively integrating or considering integrating their medical, dental, vision, and pharmacy benefits under their health and wellness programs in the next five years,...

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